2025 ISAKOS Biennial Congress In-Person Poster
A Pre-Operative Anterolateral Ligament Injury of the Knee Leads to Inferior Outcomes After Isolated Acute ACL Reconstruction With Hamstrings Graft: A Prospective Study With Minimum Five-Year Follow-Up
Camilo P. Helito, MD, PhD, Prof, São Paulo, SP BRAZIL
Paulo Helito, MD, São Paulo, SP BRAZIL
Marcel F. Sobrado, MD, PHD, São Paulo, SP BRAZIL
Andre Giardino Moreira Da Silva, MD, São Paulo, São Paulo BRAZIL
University of São Paulo, São Paulo, São Paulo, BRAZIL
FDA Status Cleared
Summary
Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 5 years after isolated ACL reconstruction with hamstring autograft
Abstract
Background
The potential influence of a preoperative anterolateral ligament (ALL) lesion seen on magnetic resonance imaging (MRI) on the mid- and long-term surgical outcomes of anterior cruciate ligament (ACL) reconstruction is still controversial.
Purpose
To evaluate the clinical outcomes and failure rate of isolated ACL reconstruction in patients with and without ALL injury diagnosed by MRI at a minimum five year follow up.
Study design: Prospective cohort study (level II evidence).
Methods
A prospective cohort of patients with acute ACL injury was divided into 2 groups based on the presence (ALL injury group) or absence (Control group) of ALL injury on preoperative MRI. This is a longer-term follow-up study of a previously published paper that had minimum 2 years follow up. Both groups underwent anatomical isolated reconstruction of the ACL. The Lysholm and subjective IKDC scores, KT-1000 and pivot shift tests, reconstruction failure rate, incidence of contralateral ACL injury, presence of associated meniscal injury and presence of knee hyperextension were evaluated. The evaluation at 5 year follow up was also compared with the same patient’s evaluation at 2 years follow up.
Results
A total of 156 patients were evaluated. No significant differences were found between the groups in the preoperative evaluation. In the postoperative evaluation, patients in the ALL injury group had a higher reconstruction failure rate (14.3% vs 4.6%;p=.049) and worse clinical outcomes according to the Lysholm scores (85.0±10.3 vs 92.3±6.3;P<.0001). Although the pivot shift was similar, anteroposterior translation by using KT-1000 revealed worse results for the ALL injury group (2.8±1.4mm vs 1.9±1.3mm; p=0.00018). Patients in the ALL injury group also presented an increase of KT-1000 values from two to five years (2.4±1.6 vs 2.8±1.4; p=0.038). Patients in the control group presented no differences in outcomes from two to five years follow up.
Conclusion
Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 5 years after isolated ACL reconstruction with hamstring autograft. Patients with concomitant ALL injury showed a higher failure rate and worse functional scores. Also, knee stability tends to slightly worsen from 2 to 5 years in cases of associated ALL injury.